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Objective: This serologic survey was performed to determine rates of HIV-1 infection among New York City (NYC) women seeking abortions., Design: Anonymous unlinked blood samples were collected and analyzed for the presence of HIV-1 antibodies. Abortion clinics were chosen for the representativeness of their patient population to all women obtaining abortions in NYC., Setting: Blood samples and demographic information, including age group, race/ethnicity, borough of residence and type of payment were obtained from 15 abortion sites (11 clinics, four hospitals) in NYC between 1987 and 1989., Participants: A total of 5889 blood samples were collected from women seeking abortions. Twelve of the 15 facilities were sampled in all 3 years., Main Outcome Measures: We determined HIV infection rates in the overall sample and in selected subpopulations, and assessed temporal trends. Stepwise logistic regression was applied to identify factors independently associated with HIV-1 infection., Results: The rate of HIV-1 infection in the overall sample was 1.19% (70 out of 5889) and remained stable in the 12 facilities sampled during all 3 years: 1987 (1.42%, 17 out of 1200); 1988 (1.67%, 20 out of 1200); and 1989 (0.90%, 27 out of 2989) (P = 0.09). Logistic regression identified receiving Medicaid and being aged between 25 and 35 years to be independently associated with HIV-1 infection., Conclusion: Approximately 1200 women seeking abortions annually in NYC are infected with HIV-1. If accessibility to elective abortion is curtailed, the number of children born to HIV-1 infected mothers will increase.

From 1987 to 1989, an epidemic of congenital syphilis was observed in New York City. A case-control study was done to assess the association between various maternal risk factors and congenital syphilis. Independent of the effect of other factors, the odds of being exposed to cocaine were 3.9 times greater among cases than controls (95% confidence interval, 2.8-5.3). This study suggests that the epidemic of congenital syphilis may be related to the increase in cocaine/crack use among delivering mothers.

Patients who attended a sexually transmitted disease clinic in New York City in 1987 were offered enrollment in a nonblinded study to estimate human immunodeficiency virus type 1 (HIV-1) seroprevalence in adults with multiple sexual partners and to determine risk factors associated with HIV-1 infection. In addition, a blinded serosurvey of a representative sample of patients was performed to obtain an unbiased estimate of seroprevalence in clinic attendees. The seroprevalence in the blinded serosurvey was 7.5% (26/348), while the seroprevalence of the 1,201 volunteers for the nonblinded study was 11.2%. For men in the nonblinded study, the risk behaviors most strongly associated with HIV-1 infection were intravenous drug use, sexual contact with another man, and sexual contact with a female intravenous drug user. For women, intravenous drug use and sexual contact with a man at risk for HIV-1 infection (an intravenous drug user or a bisexual) were most important. The seroprevalence among persons who denied all high-risk behavior was 1% (7/723). The results of this study, conducted in a city with one of the nation's highest reported cumulative incidences of acquired immunodeficiency syndrome, suggest that HIV-1 infection in clinic attendees was primarily limited to intravenous drug users, homosexual/bisexual men, and the sexual partners of these two groups.

In October and November 1987, eight cases of type E botulism occurred in New York City and Israel. All eight patients had eaten uneviscerated, salted, air-dried whitefish known as kapchunka. Clostridium botulinum was isolated from samples of fish, and trypsinized portions of kapchunka contained type E toxin despite levels of salt that were far in excess of those considered adequate for safety. As C. botulinum has been found in the viscera of fish from the Great Lakes, possible explanations for the outbreak include multiplication of C. botulinum and production of toxin during shipping or during processing before the fish reached inhibitory salt levels. However, there was no evidence of mishandling of the fish. More likely, the viscera provided a relatively low salt "protective" environment for organism multiplication and toxin production. A major public health campaign was initiated and regulations were passed prohibiting the processing, distribution, and sale of raw, uneviscerated, salt-cured fish products within New York City.

This study was done to determine whether the increase in high-level tetracycline resistant Neisseria gonorrhoeae (TRNG) was associated with increased tetracycline use. From 547 persons with positive cultures seen consecutively at a sexually transmitted disease (STD) clinic, 51 (9%) isolates were resistant to tetracycline. Of these 51 isolates, 37 (73%) had high-level resistance (TRNG) which was mediated by the tetM determinant located on a 25.2-megadalton plasmid. Women were twice as likely as men to have TRNG. Previous visits to an STD clinic and oral antibiotic use for a sexually transmitted disease within a one to five month period were used as surrogates for prior tetracycline use. Patients who had been to an STD clinic were almost twice as likely to have TRNG (RR = 1.9, 95% CI: 1.01, 3.46), and those who took an oral antibiotic had a relative risk of 1.8. The authors postulate that previous tetracycline use selects for tetM-containing microorganisms in the genitourinary tract that, at the time of gonococcal infection, have the ability to transfer the determinant to N. gonorrhoeae. The above findings might have implications for modifying the current Centers for Disease Control (CDC) recommendation to prescribe tetracycline for suspected Chlamydia infection among patients with gonorrhea.

Increasing mortality in intravenous (IV) drug users not reported to surveillance as acquired immunodeficiency syndrome (AIDS) has occurred in New York City coincident with the AIDS epidemic. From 1981 to 1986, narcotics-related deaths increased on average 32% per year from 492 in 1981 to 1996 in 1986. This increase included deaths from AIDS increasing from 0 to 905 and deaths from other causes, many of which were infectious diseases, increasing from 492 to 1091. Investigations of these deaths suggest a causal association with human immunodeficiency virus (HIV) infection. These deaths may represent a spectrum of HIV-related disease that has not been identified through AIDS surveillance and has resulted in a large underestimation of the impact of AIDS on IV drug users and blacks and Hispanics.